Provider Demographics
NPI:1497745889
Name:CRESS, JOHN C (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:CRESS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-2024
Mailing Address - Country:US
Mailing Address - Phone:616-846-0620
Mailing Address - Fax:
Practice Address - Street 1:2984 HENRY ST
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-4014
Practice Address - Country:US
Practice Address - Phone:231-737-7700
Practice Address - Fax:231-737-7701
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002494152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900F210170OtherBCBS OF MICHIGAN
MI383628290OtherTAX ID
MI383628290OtherTAX ID
MI383628290OtherTAX ID
MIMC1054410OtherDEA NUMBER
MI5375940001Medicare NSC
MIP00225596Medicare ID - Type UnspecifiedRAILROAD MEDICARE INDIVID
MIOP13290Medicare PIN
MIP13290004Medicare PIN